A nurse is caring for a client who is dying of metastatic breast cancer. She has a prescription for an opioid pain medication PRN. The nurse is concerned that administering a dose of pain medication might hasten the client's death. Which of the following ethical principles should the nurse use to support the decision not to administer the medication?

A. Polyuria: Polyuria, or excessive urination, is not typically associated with cervical spinal cord injury. In fact, urinary retention or neurogenic bladder is more commonly observed due to disruption of bladder control. Clients with cervical spinal cord injury often experience bladder dysfunction, which can lead to urinary retention rather than polyuria.
B. Hypotension: Hypotension is a common complication of cervical spinal cord injury, particularly in cases involving injury above the level of T6. Damage to the sympathetic nervous system can result in neurogenic shock, characterized by vasodilation and bradycardia, leading to hypotension. Monitoring for signs of hypotension, such as decreased blood pressure and altered mental status, is essential for early intervention and prevention of complications.
C. Weakened gag reflex: Cervical spinal cord injury can impair the gag reflex due to disruption of the glossopharyngeal nerve (CN IX) and vagus nerve (CN X) function. This impairment can lead to difficulty swallowing, aspiration risk, and increased susceptibility to respiratory complications such as aspiration pneumonia. Therefore, monitoring the gag reflex and assessing for signs of dysphagia are crucial in clients with cervical spinal cord injury to prevent respiratory compromise and aspiration-related complications.
D. Hyperthermia: Hyperthermia is less commonly associated with cervical spinal cord injury. However, in some cases, autonomic dysreflexia—a potentially life-threatening condition—can occur, leading to increased body temperature among other symptoms. This is more common in injuries above the T6 level.
E. Absence of bowel sounds: Neurogenic bowel dysfunction, including the absence of bowel sounds, is a common complication of cervical spinal cord injury. Disruption of autonomic nervous system function can lead to decreased peristalsis and absent bowel sounds.

A. Stop the enema and document that the client did not tolerate the procedure:
This option may be appropriate if the client's discomfort is severe or if there are signs of distress. However, abdominal cramps are a common sensation during the administration of an enema, especially if the bowel is distended or constipated. Therefore, stopping the procedure may not be necessary at this point.
B. Encourage the client to bear down:
Bearing down might help the client expel the enema solution and relieve some discomfort. However, if the client is already experiencing abdominal cramps, bearing down could exacerbate the discomfort and is not likely to provide immediate relief.
C. Lower the height of the solution container:
This is the correct action to take. Lowering the height of the solution container reduces the flow rate of the enema solution, which can help alleviate abdominal cramps by slowing the rate of distension of the bowel. Slowing the infusion rate allows the client's colon to accommodate to the enema more comfortably.
D. Allow the client to expel some fluid before continuing:
Allowing the client to expel some fluid before continuing may provide some relief, but it does not directly address the cause of the discomfort. Lowering the height of the solution container is a more appropriate action to address the discomfort caused by abdominal cramps during the administration of the enema.